Suppositories? Where?;Medicine in schools

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You can manage medicines in the classroom without playing doctors and nurses, writes Victoria Neumark

When he was seven, Michelle was diagnosed with asthma. Her mother felt she was too young to look after her inhaler so she asked the school to keep it and issue it whenever Michelle asked. The school refused. Either Michelle could take responsibility for her own health or she was too sick to attend lessons, it reasoned.

One child in 10 has asthma.

Gemma kept asking to go to the toilet. Sometimes she appeared grumpy or absent-minded. She was a nuisance, especially in PE and games, when she would suddenly crumple and complain. When she was diagnosed with diabetes mellitus, the other children were disgusted to learned that she had to be given sweets whenever she asked for them. "Is that fair?" they demanded.

One child in 700 has diabetes mellitus.

Freddy, aged 12, did not always seem to hear what was going on. One day, he fell and started jerking and twitching, unable to control himself. Freddy was diagnosed as having tonic-clonic epilepsy, but before he had stabilised on his dosage of medicine, his maths teacher was terrified when Freddy collapsed on the floor, locked in one continuous seizure - so-called Status Epilepticus. He immediately called the ambulance and paramedics administered diazepam rectally. But it was a near thing.

One child in 100 has epilepsy.

It was a great relief for his teachers and parents when, at the age of nine, Nathan was prescribed Ritalin for attention deficit hyperactivity disorder (ADHD). Staff were delighted at the improvement in Nathan's attention span but less delighted at the idea of having to make sure he took his pills at lunch-time.

Between one and three children in every 100 has ADHD.

Harish cannot eat peanuts. He touched his friend's peanut-butter sandwich once and fainted. His reaction suggested he may be at risk of injury or death from anaphylactic shock. His parents are worried that he may accidentally contact peanuts in the dining hall. The school refuses to allow him to go on a trip. Harish is upset.

Thousands of children are at risk of anaphylaxis, which can be caused by allergies to peanuts, dairy products, shellfish, peanuts, pet hair, penicillin and stinging insects.

Health problems can and should be managed within mainstream education, says Joe Harvey, director of the Health Education Trust. "The core is communication, understanding and responsibility,'' he adds. He believes passionately that children with medical problems should not be marginalised; medication can be managed within school without turning education personnel into doctors and nurses.

Newspapers still run headlines such as "School's drug ban on sick pupil, 9" or "School demands pound;1.39 a day to give sick boy his pills''. Staff worry that if they accept responsibility for medication they may end up legally responsible for any worsening of illness. Add to that the slippery slope argument: look after the inhalers and the next thing you know you'll have to administer diazepam rectally. What next - open-heart surgery? Yet children who need medicine have just as much right to the curriculum as anyone else and, with proper planning and consultation, a school can cope with most common conditions.

There is no statutory requirement for local authorities or schools to have policies about medicines, so funds will be discretionary. Some authorities, like Birmingham, have implemented, monitored and evaluated policies. Others regard the issue as a health matter and others have not yet recognised that there is a problem. Therefore, the onus is on individual schools.

With minor illnesses, schools have three options: to agree to offer help; to request that parents ask doctors to time medication so it need not be given in school hours; or to refuse to take a position. With common diseases such as asthma, school managers need to familiarise themselves and their staff with the implications. Knowledge will dispel fear, and enable staff to come to an informed decision as to how much support they wish to offer.

Just as it is important not to be afraid of a condition like epilepsy, it is equally important not to dismiss a condition like anaphylactic shock (when the body "shuts down" in allergic reaction) as "nothing to worry about". Properly considered procedures can give staff the confidence to deal with emergencies as well as day-to-day routines. Open discussion between staff, parents and pupils can remove stigmatising attitudes, such as epileptics being mocked as "Fitface", and prevent potentially damaging folklore remedies, like forcing pencils between their teeth. It is all about communication. The whole school needs to be aware of a health policy, says Harvey.

Schools may baulk at the additional costs in time and money of training, consultative meetings with parents, and drawing up health management plans for each affected pupil. The independent health plan (IHP) is the key to trouble-free support for ill children, but it demands time and effort - although for each child only vital staff, such as form tutors, need to be fully involved.

So, once you have had whole-school training, drawn up a health policy, established independent health plans for all your children with medical needs and informed all parents of how far you are prepared to assist their children medically, how would you deal with Michelle, Gemma, Freddy, Nathan and Harish?

Asthma: Subject to a child's maturity, he or she should have access to an emergency inhaler at all times. Teachers must respect any signs of wheeziness or a child's wish to stop exercise.

Diabetes mellitus: Toilet use must not be restricted. Sugary snacks must be available for hypoglycaemia when blood sugar drops to a dangerous low. Plan ahead for outings, to ensure that injections will be timed correctly. Look out for mood swings - they are signs of fragile blood-sugar levels.

Epilepsy:The dramatic seizure is no worse than the "absences" of so-called petit mal. Be aware that some kinds of seizure can seem more like psychiatrically disturbed behaviour (autonomic movements, vocalisations). Institutea "buddy" system tohelp children catch up with missed experiences. Train staff in use of diazepam.

ADHD: Look for recurrences of difficult or challenging behaviour as indications of wrong dosage.

Anaphylaxis: Keep a spare adrenaline pen in a known place and familiarise staff with its use. Alert staff to dangers of pets, biscuits, wasps, etc. Plan trips with first aid in mind.

Above all, respect the dignity of the child.

The Department for Employment and Education's 'Good Practice Guide' has forms for keeping records; specialist organisations can offer advice and training; and local authorities will advise on responsibilities.

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